ESBD_392780_1737991254417_SOL_EXH_F.4_AP-152.pdf

SIC

code

5. Mailing address where you want to receive payments

6. (Optional)

7. (Optional)

8. (Optional)

9. City State ZIP code

10.

Payee telephone number (Area code and number)

Security type code ( 0, 1, 2 )

Zone code

(SSN)Social Security number (9 digits)

Individual Taxpayer Identification Number (ITIN) (9 digits)

Enter the number indicated

If "YES," enter Texas Taxpayer Number

1. Is this a new account? YES Mail Code 000 NO Enter Mail Code Agency number Complete Sections 1 - 5 Complete Sections 1, 2 & 5

For Comptroller's use only

11. Ownership Codes - Check only one code by the appropriate ownership type that applies to you or your business.

L - Texas Limited Partnership:

If checked, enter the

Texas File Number

Owner's name

T - Texas Corporation:

If checked, enter the Texas File Number

SSN / ITIN (9 digits) A - Professional Association:

If checked, enter the Texas File Number

If checked, enter the exas File Number

C - Professional Corporation:

T

Name

SSN / ITIN / EIN (9 digits)

Name

SSN / ITIN / EIN (9 digits)

I - Individual Recipient (not owning a business)

P - Partnership: If checked, enter two partner's names and

O - Out-of-State Corporation

G - Governmental Entity

U - State agency / University

F - Financial Institution

R - Foreign (out of U.S.A.)

N - Other: If checked, explain.

12. Payment Assignment? YES NO Note: A copy of the assignment agreement between payees must be attached.

Assignee name

Assignee TIN Assignment date

13. Comments Authorized signature (Applicant or authorized agent) Date

14.

Agency name Prepared by Phone (Area code and number)

15.

AP-152

(Rev.8-21/18)

Application for Texas Identification Number

• See instructions on back

Se ct io n

Se ct io n

Se ct io n

Se ct io n

Se ct io n

Form AP-152 (Back)(Rev.8-21/18)

Application for Texas Identification Number Instructions G L E N N H E G A R T E X A S C O M P T R O L L E R O F P U B L I C A C C O U N T S

to bill agencies of the state government for goods, services provided, refunds, public assistance, etc. When the application is processed by the

the completed application to the state agency with which the applicant is conducting business.

application or with processing the form.

Specific Instructions Item 1: Is this a new account?

Select YES if the applicant has never received a payment from a Texas state agency and does not have an assigned TIN.

Select NO if the applicant has received payments from a Texas state agency and already has an assigned TIN.

Mail Code / Agency number – Will be entered by the state agency that processes the application.

agency that needs to pay a foreign entity or a foreign individual who does not have an EIN, SSN or ITIN.

Current Texas Identification Number (FOR STATE AGENCY USE ONLY): The 11-digit current Comptroller-assigned TIN.

and begin the address in Item 6.

Item 9: Enter the city, state and ZIP code.

Item 10: Enter the payee telephone number.

SIC code / Security type code / Zone code – These fields will be completed by the state agency that will process the application.

Section 4 — Payment Assignment Item 12: Select YES if the payee is assigning its payments to a third party and the state agency that will process the application has ap-

attached.

Select NO if the payee is not assigning its payments to a third party.

date signed.

Item 15: Agency name, Prepared by, Phone: Will be entered by the state agency that will process the application.

Under Ch. 559, Government Code, you are entitled to review, request and correct information we have on file about you, with limited exceptions in accordance with Ch. 552, Government Code. To request information for review or to request error correction, contact us at the address or phone numbers listed on this form.

https://fmx.cpa.texas.gov/fm/pubs/payment/ mailto: tins.mail@cpa.texas.gov